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Query: UMLS:C0038454 (stroke)
 147,016 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Autonomic cardiovascular regulation was evaluated in 35 women, 19 with mitral valve prolapse and 16 healthy controls. Heart rate responses to the diving reflex and to phenylephrine infusion were diminished in patients. Noninvasive measures of cardiac output, heart rate, blood pressure, forearm flow and leg volume during lower body negative pressure (LBNP) showed that patients had less lower extremity pooling of blood and had lower forearm conductance. Blood pressures during LBNP rose or remained unchanged despite decreases in cardiac output of 20--25%. These data indicate that mitral valve prolapse patients have an increased venous and arterial vasoconstrictor activity. Cardiac output at rest and echocardiographic indices of contractility were normal. Patients with a history of significant ventricular arrhythmias had higher heart rates and lower forward stroke volumes than the other patients or controls. The combined data demonstrate autonomic dysfunction in women with the mitral valve prolapse syndrome and suggest decreased parasympathetic, increased alpha- and normal beta-adrenergic tone and responsiveness.
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PMID:Autonomic dysfunction in women with mitral valve prolapse syndrome. 42 2

Thromboembolism (TE) occurs in about 20% of patients with rheumatic mitral valve disease, and platelet survival time in these patients has correlated with TE. In patients with mitral valve prolapse, TE appears to occur very infrequently. Platelet survival (autologous labeling with chromium-51) was performed in 26 patients with mitral prolapse. Five patients had a history of stroke, as well as normal cerebrovascular arteriography and shortened platelet survival (average half-time +/- SEM 2.3 +/- 0.18 days; normal half-time 3.7 +/- 0.03 days; n = 26; p less than 0.01). Platelet survival was shortened in seven of 21 patients without TE (33%) (3.3 +/- 0.06 days; p less than 0.01 vs patients with TE). In 138 patients with rheumatic heart disease, platelet survival was shortened in 40 of 41 (98%) with a history of TE (2.3 +/- 0.08 days) and in 76 of 97 (78%) without TE (2.9 +/- 0.07 days; p less than 0.001 vs patients with TE). In patients with mitral prolapse, sulfinpyrazone increased platelet survival (2.4 +/- 0.16 to 2.7 +/- 0.19 days; n = 7; p less than 0.05). Our results suggest that platelet survival time is shortened in patients with mitral prolapse and rheumatic heart disease who have had TE. Of those without TE there is an increased frequency of shortened platelet survival in patients with rheumatic heart disease (78%) compared with those with mitral prolapse (33%), consistent with the infrequency of TE in mitral prolapse.
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PMID:Platelet survival time and thromboembolism in patients with mitral valve prolapse. 44 32

ECG, PCG, CSG and ACG were synchronously recorded in 25 patient with non-expulsion click syndrome -- telesystolic murmur as well as in 62 cardiac healthy subjects. With the investigation of the systolic and diastolic intervals, a prolongation of the transformation period was established (Q--1 = 72 +/- 12 msec) and a shortening of the isovolumetric relaxation (A2--0 = 63 +/- 10 msec). The ratio PPE/LVET (period prior to expulsion/left venticular expulsion time) is normal in patients with nonexpulsion click -- telesystolic apical murmur but the comparison of PPE/LVET with a normal contraction with that of the first post extrasystolic contraction shows a statistically significant shortening. The ratio PPE/LVET in prolapse of the mitral valve prior to extrasystole is 0.39 +/- 0.02, and during the first contraction with intensified stroke after a compensatory pause is 0.31 +/- 0.03 (p less than 0.02). The possibility for explanation of the changes in phase analysis are discussed and a conclusion is drawn that they reflect the existence of deviation in the left ventricular mechanics and hemodynamics in case of mitral valve prolapse.
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PMID:[Phase analysis of the normal and postectopic left ventricular contractions in nonejection click-telesystolic apical murmur syndrome]. 51 58

Sixty-seven patients (27.9%) between 16 and 45 years, out of 240 cases of stroke seen over 33 months were further studied with respect to stroke type, aetiological and social factors. The frequency of non-embolic cerebral infarction was 58.2%, cerebral embolism 7.5%; cerebral haemorrhage 17.9%; primary subarachnoid haemorrhage 11.9%. Hypertension was the commonest aetiological factor occurring in 35.8% of the cases. Cervical spine hyperflexion, stenosing carotid arteritis, cocaine ingestion, mitral valve prolapse, non-valvular atrial fibrillation and chorion cancer featured among other less frequent but important factors presenting different diagnostic problems. The frequency of unexplained stroke was under 12%. The authors suggest that previously encountered cervical spine trauma among young stroke cases represent underreporting and that the relationship between young age, grand-multiparity and non-valvular atrial fibrillation be further elucidated.
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PMID:Stroke at the prime of life: a study of Nigerian Africans between the ages of 16 and 45 years. 139 94

The risk factors of ischemic cerebrovascular disorders in 77 young patients (< or = 40 years) were compared to those in 138 older patients (> 40 years). The risk factor profile of patients with juvenile stroke was considerably different from that of older patients. Migrainous headache and mitral valve prolapse occurred more frequently in the younger age group, whereas hypertension, diabetes mellitus, high levels of cholesterol and triglycerides were found more often in older patients with stroke. 65% of the women under the age of 40 took oral contraceptives which compares to the baseline community value of 28% of women in childbearing age in this country. Cardiac disorders such as atrial fibrillation, left ventricular hypertrophy, coronary heart disease including a history of myocardial infarction, as well as mitral valve disease were demonstrated more often in the group of elderly patients. 7 out of 77 younger patients (9.1%), and 59 out of 138 older patients (42.8%) were considered to belong to a group with "high cardiac risk for stroke". The results of this study indicate that electrocardiographic screening is of prime importance for detecting cardiac risk factors. However, echocardiographic examination often yields additional diagnostic information, particularly in younger patients. The conflicting opinions concerning the relevance of certain risk factors for ischemic stroke could partly be explained by the fact that these risk factors are distributed unevenly depending on age.
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PMID:Different risk factor profiles in young and elderly stroke patients with special reference to cardiac disorders. 146 Apr 76

Thrombus formation in the left atrium and left ventricle is primarily due to stasis of blood which causes activation of the coagulation system. Migration of thrombotic material into the circulation depends on the dynamic forces of the circulation. Atrial fibrillation is the commonest underlying cardiac disorder predisposing to thromboembolism. Rheumatic mitral stenosis, left atrial enlargement, prior myocardial infarction, hypertension, and echocardiographic left ventricular hypertrophy are risk factors for thromboembolic stroke in elderly patients with chronic atrial fibrillation. Non-valvular atrial fibrillation accounts for 45% of cardiac sources of thromboembolic stroke and includes patients with ischemic heart disease, hypertension, thyrotoxic heart disease, hypertrophic cardiomyopathy, chronic sinoatrial disorder, and idiopathic atrial fibrillation. 15% of cardiac sources of thromboembolic stroke are associated with acute myocardial infarction, 10% with left ventricular aneurysm and mural thrombi remote from an acute myocardial infarction, 10% with rheumatic valvular heart disease, and 10% with prosthetic cardiac valves. Mitral valve prolapse, mitral annular calcium, nonischemic cardiomyopathies, infective endocarditis, nonbacterial thrombotic endocarditis, left atrial myxoma, paradoxical embolism associated with congenital heart disease, calcific aortic stenosis, and complex atherosclerotic plaque within the proximal aorta also contribute to thromboembolism.
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PMID:Etiology and pathogenesis of thromboembolism. 176 43

Twenty patients with different types of muscular dystrophy (MD) were included in a cross-sectional study by means of electrocardiography and ultrasound cardiography. A manifest cardiomyopathy was detected in 8 patients; a latent cardiomyopathy was found in 4. A hypertrophic cardiomyopathy was especially frequent in facioscapulohumeral MD, a congestive cardiomyopathy in Becker-Kiener MD. The ECG showed a reduction in the QT interval and frequent block formers in the X-chromosomal inherited forms and the trunc-girdle form. Bradycardia and a prolonged QT interval were frequent in myotonic dystrophy and facioscapulohumeral MD. Signs of cardiac infarction in the ECG were most frequent in the trunc-girdle forms. A high cardiac output per minute in conjunction with increased left ventricular volume was frequent in Becker-Kiener and Landouzy MD. A left ventricular dysfunction with reduced ejection was characteristic of myotonic dystrophy and trunc-girdle MD. A mitral valve prolapse was more frequent with increasing severity of the muscle disease and was particularly frequent in myotonic dystrophic and Landouzy MD. The cardiac output per minute and the stroke volume were significantly lower (P less than or equal to 0.03) where a mitral valve prolapse was present.
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PMID:The heart in muscular dystrophy: an electrocardiographic and ultrasound study of 20 patients. 179 Jan 64

In this study, we tried to characterize the changes in left ventricular (LV) function and coronary hemodynamics in patients with compensated hypertension (HT) who were free from coronary artery disease. The study group consisted of 10 men with compensated essential HT at ages 48-65 years (mean = 58). The durations of HT history for the various patients ranged from 5 to 14 years. Mean arterial pressure (MAP) was 122 +/- 2 mmHg at the time of study. The control group was composed of 8 men with mild mitral valve prolapse. They were studied because of chest pain with no demonstratable pathological conditions. Their ages ranged from 39 to 65 years (mean = 57). The MAP for controls was 86 +/- 3 mmHg. All patients in both groups underwent routine cardiac catheterization, coronary arteriography, and measurements of the coronary sinus (CS) and great cardiac vein (GCV) blood flows. Left ventricular muscle mass (LVMM), coronary resistance and coronary reserve were also derived from the hemodynamic study. There was a significant difference in the LVMM index between the study patients (114.9 g/m2) and the control subjects (96.8 g/m2, p less than 0.001). The LV function of the patients in the study group was essentially normal, but the following parameters were significantly different from those of the control subjects: cardiac index, stroke volume index, and dp/dtmax. There was a good correlation between repeated measurements of both the CS and GCV blood flows (r = 0.97 for both).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The coronary hemodynamics and left ventricular function in patients with compensated hypertension. 197 57

The diagnostic yield of transesophageal and transthoracic echocardiography for identifying a cardiac source of embolism was compared in 79 patients presenting with unexplained stroke or transient ischemic attack. There were 35 men and 44 women with a mean age of 59 years (range 17 to 84); 52% had clinical cardiac disease. Both transthoracic and transesophageal echocardiograms were performed using Doppler color flow and contrast imaging. Transesophageal echocardiography identified a potential cardiac source of embolism in 57% of the overall study group compared with only 15% by transthoracic echocardiography (p less than 0.0005). Compared with transthoracic echocardiography, transesophageal echocardiography more frequently identified atrial septal aneurysm associated with a patent foramen ovale (9 versus 1 of 79 patients, p less than 0.005), left atrial thrombus or tumor (6 versus 0 of 79 patients, p less than 0.05) and left atrial spontaneous contrast (13 versus 0 of 79 patients, p less than 0.0005). All cases of left atrial thrombus or spontaneous contrast were identified in patients with clinically identified cardiac disease. In the 38 patients with no cardiac disease, transesophageal echocardiography identified isolated atrial septal aneurysm and atrial septal aneurysm with a patent foramen ovale more frequently than transthoracic echocardiography (8 versus 2 of 38 patients, p less than 0.05). The two techniques had a similar rate of identifying apical thrombus and mitral valve prolapse. Overall, transesophageal echocardiography identified abnormalities in 39% of patients with no cardiac disease versus 19% for transthoracic echocardiography (p less than 0.005). Thus, transesophageal echocardiography identifies potential cardiac sources of embolism in the majority of patients presenting with unexplained stroke.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. 198 42

Mitral valve prolapse is found in 2-5% of the whole population and is thus the most common valvular anomaly. The vast majority of patients are asymptomatic and remain free of complications during the follow-up. The most important complications are severe mitral regurgitation, bacterial endocarditis, cerebral ischemic stroke and arrhythmias. The risk of these complications is increased in patients with a holosystolic murmur, enlarged left atrium and/or ventricle, and redundant, thickened mitral leaflets. The complication rate increases with age and is generally higher in males. The risk of complications is very low in patients with an isolated systolic click or silent prolapse. Prophylactic treatment for endocarditis is recommended for patients with a systolic murmur. For patients surviving ischemic stroke, aspirin is recommended. Where the left atrium is enlarged and rhythm disturbances are present, anticoagulation treatment is preferable. Rhythm disturbances should be treated only when symptomatic. In cases of severe mitral regurgitation surgery should be considered early, since reconstruction of the valve can be achieved in the majority of patients.
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PMID:[Mitral valve prolapse--clinical significance of a frequent diagnosis]. 204 27


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